Goguen Laura A, Chapuy Claudia I, Li Yi, Zhao Sihai D, Annino Donald J
Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Arch Otolaryngol Head Neck Surg. 2010 Nov;136(11):1071-7. doi: 10.1001/archoto.2010.188.
To determine the incidence of postchemoradiotherapy (post-CRT) neck dissection (ND) complications; to ascertain whether timing (< 12 vs ≥ 12 weeks) from CRT to ND or other factors are associated with increased complications; and to determine whether ND timing influences disease control or survival.
Ten-year retrospective analysis.
Tertiary care center.
One hundred five patients with head and neck cancer undergoing ND after CRT.
Complications and survival variables compared between groups undergoing ND less than 12 weeks (less-than-12-weeks ND group) and 12 weeks or more (12-weeks-or-more ND group) after CRT.
Sixty-seven NDs were performed less than 12 weeks and 38 were performed 12 weeks or more after CRT. Patient characteristics, treatment, and ND pathology results were comparable between the 2 ND groups. The incidence of complications between the less-than-12-weeks and the 12-weeks-or-more ND groups included major wound complications in 8 of 67 (11.9%) vs 1 of 38 (2.6%; P = .15), minor wound complications in 11 of 67 (16.4%) vs 4 of 38 (10.5%; P = .56), airway complications in 7 of 67 (10.4%) vs 2 of 38 (5.3%; P = .48), and systemic complications in 9 of 67 (13.4%) vs 2 of 38 (5.3%; P = .32). The number of patients with at least 1 complication was significantly smaller in the 12-weeks-or-more ND group (P = .04). Multivariate analysis showed that radical ND was significantly associated with an increased number of complications, and higher radiation doses approached significance (P = .05). Induction chemotherapy was associated with fewer wound complications (P = .01). There were no significant differences in overall survival (P = .82), progression-free survival (P = .77), or regional relapse (P = .54) between groups. Positive ND findings were associated with diminished progression-free and overall survival.
These findings indicate that ND can be safely performed 12 weeks or more after CRT without adversely affecting surgical complications or survival variables.
确定放化疗后颈部清扫术（post-CRT ND）并发症的发生率；确定从放化疗至颈部清扫术的时间（<12周与≥12周）或其他因素是否与并发症增加相关；并确定颈部清扫术的时间是否会影响疾病控制或生存率。
十年回顾性分析。
三级医疗中心。
105例头颈部癌患者在放化疗后接受颈部清扫术。
比较放化疗后不到12周接受颈部清扫术的组（<12周颈部清扫术组）和12周或更长时间接受颈部清扫术的组（12周或更长时间颈部清扫术组）之间的并发症和生存变量。
67例颈部清扫术在放化疗后不到12周进行，38例在放化疗后12周或更长时间进行。两组颈部清扫术患者的特征、治疗及颈部清扫术病理结果具有可比性。<12周颈部清扫术组与12周或更长时间颈部清扫术组的并发症发生率包括：严重伤口并发症分别为67例中的8例（11.9%）与38例中的1例（2.6%；P = 0.15），轻微伤口并发症分别为67例中的11例（16.4%）与38例中的4例（10.5%；P = 0.56），气道并发症分别为67例中的7例（10.4%）与38例中的2例（5.3%；P = 0.48），全身并发症分别为67例中的9例（13.4%）与38例中的2例（5.3%；P = 0.32）。12周或更长时间颈部清扫术组中至少有1种并发症的患者数量明显较少（P = 0.04）。多因素分析显示，根治性颈部清扫术与并发症数量增加显著相关，较高的放疗剂量接近显著水平（P = 0.05）。诱导化疗与较少的伤口并发症相关（P = 0.01）。两组之间的总生存期（P = 0.82）、无进展生存期（P = 0.77）或区域复发（P = 0.54）无显著差异。颈部清扫术阳性结果与无进展生存期和总生存期缩短相关。
这些结果表明，放化疗后12周或更长时间可安全地进行颈部清扫术，且不会对手术并发症或生存变量产生不利影响。
